Background: Anastomotic biliary stricture represents one of the possible factors leading to liver dysfunction after transplantation. Purpose: Our aims were to evaluate the role of endoscopic retrograde cholangio-pancreatography and a short-term stenting (stent-trial) in assessment of the clinical relevance of the biliary stricture. Materials and methods: Thirty transplanted patients for HCV (n = 17) or non-HCV (n = 13)-related cirrhosis (27 M, median age 53 yr, range 24-67 yr) who developed persistently abnormal liver function tests and presented with an anastomotic biliary stricture suggested by non-invasive cholangiography, underwent endoscopic retrograde cholangio-pancreatography. If the stricture was confirmed, dilation was performed and a plastic stent was placed. Clinical and biochemical evaluation was done one and two months later. Resolution of symptoms and normalization or > 50% reduction of at least one liver function test were needed to consider the stricture as clinically relevant. Patients were followed up for a median of 19 months. Results: Endoscopic retrograde cholangio-pancreatography was successful in 29 patients and confirmed the anastomotic biliary stricture in 19 (66%); 14 patients underwent endoscopic dilation and stenting and five patients underwent surgery. The stent-trial suggested the stricture to be clinically relevant in 7 of 14 patients, confirmed by prolonged stenting and follow-up. A trend towards a higher likelihood of a clinically relevant stricture was observed in HCV-negative compared to HCV-positive patients (5 of 7, 71% vs 2 of 7, 29%, respectively; p = 0.1). Conclusions: Our data suggest that endoscopic retrograde cholangio-pancreatography is a valuable tool to evaluate the clinical relevance of an anastomotic stricture, when coupled with a short-term stent-trial.
ERCP and short-term stent-trial in patients with anastomotic biliary stricture following liver transplantation / P. Cantù, A. Tenca, M.F. Donato, G. Rossi, L. Forzenigo, L. Piodi, C. Rigamonti, F. Agnelli, P. Biondetti, D. Conte, R. Penagini,,. - In: DIGESTIVE AND LIVER DISEASE. - ISSN 1590-8658. - 41:7(2009), pp. 516-522.
|Titolo:||ERCP and short-term stent-trial in patients with anastomotic biliary stricture following liver transplantation|
TENCA, ANDREA (Secondo)
CONTE, DARIO (Penultimo)
PENAGINI, ROBERTO (Ultimo)
|Settore Scientifico Disciplinare:||Settore MED/12 - Gastroenterologia|
|Data di pubblicazione:||2009|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.dld.2008.08.002|
|Appare nelle tipologie:||01 - Articolo su periodico|